High burden of anti-microbial resistance among neonatal blood stream infections in Southeast Asia: results of the NeoSEAP study

Abstract

BackgroundProgress on neonatal sepsis has remained modest in recent decades and is threatened by the global rise of antimicrobial resistance. The Southeast Asian region has a high burden of both neonatal sepsis and antimicrobial resistance. Despite this, their remains a lack of robust epidemiological data on the causes of neonatal sepsis and the prevalence of AMR in the region.MethodsWe evaluated the causes of neonatal sepsis and AMR burden in 10 sites across five countries in South and Southeast Asia (Sri Lanka, Indonesia, The Philippines, Malaysia and Vietnam). Retrospective data on all blood cultures collected from neonates between 1stJanuary 2019 – 31stDecember 2020 were extracted from laboratory records. Data were also collected on the availability of clinical resources, the implementation of infection prevention and control strategies, and antimicrobial prescribing practices.FindingsA total of 1,528 blood cultures were positive for significant isolates over the study period. Gram-negative pathogens predominated (1,163/1,528, 76.1%) with the most frequently isolated pathogensKlebsiellaspp. (408/1,528, 26.7%) andAcinetobacterspp. (261/1,528, 17.08%) Among Gram-negative Enterobacteriaceae pooled resistance to ampicillin, gentamicin, third-generation cephalosporins (ceftriaxone and/or cefotaxime) and carbapenems was 75% (193/257), 59% (393/665), 67% (441/655) and 18.6% (125/672). For Gram negative non-Enterobacteriaceae resistance to gentamicin and carbapenems was 76.6% (326/282) and 69.7% (207/297).InterpretationNeonatal sepsis among study sites was caused predominantly by Gram-negative pathogens and associated with high levels of non-susceptibility to common empirical treatment regimes.